. Diseases of the rectum and anus: designed for students and practitioners of medicine. constantpressure exerted upon these muscles by the fecal mass, theyoccasionally become hypertrophied, and must be considered inthe treatment of constipation. The author has in three casesfound it necessary to sever the attachment of the levators anito the coccyx by a subcutaneous tenotomy; in two other casesthe same end was accomplished by means of a posterior me-dian incision exposing the coccyx, which was then elevatedwith a strong, dull-pointed hook caught under its tip, and thusheld while the attachment
. Diseases of the rectum and anus: designed for students and practitioners of medicine. constantpressure exerted upon these muscles by the fecal mass, theyoccasionally become hypertrophied, and must be considered inthe treatment of constipation. The author has in three casesfound it necessary to sever the attachment of the levators anito the coccyx by a subcutaneous tenotomy; in two other casesthe same end was accomplished by means of a posterior me-dian incision exposing the coccyx, which was then elevatedwith a strong, dull-pointed hook caught under its tip, and thusheld while the attachment of the levator ani was severed. Thehook was then removed and the external wound closed by asufficient number of interrupted catgut sutures. When theposterior bony attachment of the levatores ani muscles havebeen destroyed, they no longer contract about the rectum suf-ficiently to obstruct the passage of the feces. The authortreated one case in which the hypertrophied levator ani mus- In most instances, this operation should be performed under local anesthesia. See,Chapter XLI. / ^. ^ ^ > e1^ !5 ?* 8 W tl •*- e 5 ^ -. *~ « ^ C D. Q V > u: rt C3 s = t:] CONSTIPATION 103 cles could be distinctly outlined by the finger in the rectum,especially when the patient was requested to draw the anusupward; severing of the coccygeal attachment in this case gaveno relief, and a myotomy was subsequently made. This operation was performed as follows: Through aposterior median incision extending from the lower end of thesacrum to within half an inch ( centimeters) of the anusthe coccyx was removed, and the muscles severed on either sideat the point where they cross the rectum. That portion of themuscles which had extended from the rectum to the coccyx wasdetached from the rectum and removed. The external woundwas then closed with interrupted catgut sutures and dressingsapplied. The patient promptly recovered from the operation,and was gradually relieved of his constipation. None of
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectanusdis, bookyear1910
